Study In Melbourne Research Articles

A hood for a hawk: when to use chaperones in sexual health clinics

Rogstad’s editorial1 on chaperones for intimate examinations in sexual health clinics provided a comprehensive discussion of the issues and competing interests. However, we consider that her recommendations are too prescriptive. Will chaperones reduce false allegations by patients, or reduce the likelihood of offensive behaviour by a clinician? Medical defence organisations may have such data, but in our experience they appear unwilling to share it. In Maw’s survey of genitourinary medicine clinics,2 at least 10 of the 13 complaints about examinations occurred with a chaperone in attendance, and in the only case progressing to litigation a chaperone had been present. We are unaware if complaints are more likely in Australia compared with the UK, or if patient satisfaction is less, given chaperones are less frequently used in Australia.3 Our study4 found that only 1% of men wanted a chaperone; 4% of women wanted a chaperone if being examined by a female; and if being examined by a man, 32% of women wanted a chaperone, 40% did not care, and 29% did not want a chaperone. Remarkably similar results were found in a similar study inMelbourne.5 In our study, the strongest association with women wanting a chaperone was preferring a female clinician (adjusted odds ratio 6.6). Therefore, providing preferred gender of clinician will dramatically reduce requests by women for chaperones. With these results in mind, we make the following recommendations. At reception or triage, advise patients of the probable practitioner they will see – this will allow those preferring a female clinician to request one, if available. The patient registration form can contain a statement about chaperones, such as: ‘If you wish to have a chaperone during the examination, please tick the following box. A chaperone is an additional health care person to be present during your examination.’ This satisfies conservative recommendations to offer a chaperone for all intimate examinations.1 Information pamphlets or a poster could provide more information about the service’s policy, and availability (or unavailability) of genderspecific clinicians and chaperones. After taking the medical history, female clinicians need not offer a chaperone.

‘Only by persistent effort in the face of discouragement’: Eugenics and Australian civic and school playgrounds, 1900–1920*

(1996). ‘Only by persistent effort in the face of discouragement’: Eugenics and Australian civic and school playgrounds, 1900–1920. Melbourne Studies in Education: Vol. 37, No. 2, pp. 129-148.

The politics of discourse: Academic responses to the Dawkins reforms of higher education, 1945–1991*

(1992). The politics of discourse: Academic responses to the Dawkins reforms of higher education, 1945–1991. Melbourne Studies in Education: Vol. 33, No. 1, pp. 35-55.

Economic Evaluation of Australian Stroke Services

Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs). A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications. The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (P=0.024), but borderline for SCU (n=102, P=0.08; 12,251 Australian dollars; 15,903 Australian dollars; 15,383 Australian dollars respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was 9867 Australian dollars per patient achieving thorough adherence to clinical processes and 16,372 Australian dollars per patient with severe complications avoided, based on costs to 28 weeks. Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.

Distribution and seasonal biomass of drift macroalgae in the Indian River Lagoon (Florida, USA) estimated with acoustic seafloor classification (QTCView, Echo plus)

Three areas of the Indian River Lagoon, Florida (USA) were surveyed to show seasonal changes in the distribution and biomass of macroalgae and seagrass. Acoustic seafloor discrimination based on first and second echo returns of a 50 kHz and 200 kHz signal, and two different survey systems (QTCView and ECHO plus) were used. System verification in both the field and a controlled environment showed it was possible to distinguish acoustically between seagrass, sparse algae, and dense algae. Accuracy of distinction of three classes (algae, seagrass, bare substratum) was around 60%. Maps were produced by regridding the survey area to a regular grid and using a nearest-neighbor interpolation to provide filled polygons. Biomass was calculated by counting pixels assigned to substratum classes with known wet-weight biomass values (sparse algae 250 g m − 2 , dense algae 2000 g m − 2 , seagrass 100 g m − 2 ) that were measured in the field. In three study areas (Melbourne, Sebastian Inlet, and Cocoa Beach), a dependence of algal biomass on depth and season was observed. Seagrass most frequently occurred in water less than 1 m deep, and in November, seagrass beds tended to be covered by dense algae that also extended up- and downstream of shoals in the Lagoon. In March, the pattern was similar, with the exception that some areas of previously dense algae had started thinning into sparse algae. Macrophyte biomass was lowest in May in the Melbourne and Cocoa Beach study areas, with the opposite situation in the Sebastian Inlet study area. In May, seagrass areas were largely devoid of dense algae and most algae accumulations were sparse. In August, dense algae covered large areas of the deep Lagoon floor while shoals were largely free of algae or had only sparse cover. We suggest this summer pattern to reflect moribund algae being washed from the shallows to deeper channels and from there being removed from the lagoonal ecosystem either through tidal passages into the open ocean or by degradation and breakdown in situ. The differences between the study areas indicate high spatial and temporal variability in biomass and distribution of macrophyte biomass in the Indian River Lagoon.

Asthma and older people in general practice

WHAT WE NEED TO KNOW: Why is there undiagnosed and untreated asthma in older people in the community and in general practice? What patient, general practitioner and organisational factors contribute to this? Are current best practice guidelines appropriate for older people with asthma? WHAT WE NEED TO DO: Undertake broad community and general practice screening to identify characteristics of older people with undiagnosed asthma. Analyse GPs' perspectives and decision-making processes for older people with dyspnoea. Undertake targeted research in general practice, trialling decision-making frameworks for older patients with dyspnoea. Undertake appropriate and relevant community and GP awareness campaigns about the prevalence of asthma in older people. Analyse current best practice management of asthma, including self-management and the Asthma 3+ Visit Plan, in older people.

Large‐Artery Stiffness Contributes to the Greater Prevalence of Systolic Hypertension in Elderly Women

To determine whether sex differences in large-artery stiffness contribute to the greater prevalence of systolic hypertension in elderly women than in elderly men. During a single visit arterial stiffness was assessed in the unmedicated state using four parameters. Three hundred seventy-four women with a mean age+/-standard deviation of 72+/-5 and 296 men aged 71+/-5 participated. Hypertensive patients were recruited from general practice as part of the second Australian National Blood Pressure Study in Melbourne, Australia. Large-artery stiffness was assessed using multiple methodologies, including aortic arch stiffness (beta-index) using M-mode ultrasound and arterial compliance and augmentation index using noninvasive carotid pressure and aortic flow measurements. Women had greater carotid and brachial pulse pressure (PP) than men (P<.001), despite higher mean arterial pressure in men. Mean arterial compliance was lower in women (0.20+/-0.12 vs 0.28+/-0.16 mL/mmHg, P<.001) even after correction for aortic area, and aortic arch stiffness was higher (30+/-36 vs 23+/-22; P<.01). Consistent with both a stiffer proximal circulation and a shorter distance to reflection sites, women had higher augmentation index (38+/-11% vs 29+/-12%, P<.001). In multivariate analysis, sex was an independent determinant of all arterial stiffness indices. Independently of known confounders, elderly hypertensive women have stiffer large arteries, greater central wave reflection, and higher PP than elderly men. Stiffer large arteries likely contribute to the greater prevalence of systolic hypertension in elderly women and may partly explain the acceleration in postmenopausal cerebrovascular and cardiac complications.

Localization of cortical cataract in subjects of diverse races and latitude.

To compare the characteristics of early cortical cataract localization in three groups in cataract epidemiologic surveys performed in Reykjavík, Melbourne, and Singapore. Individuals who had right eyes with an area of cortical opacity less than 20% of the pupil when dilated 7 mm or more were selected as subjects. This included 197 subjects from the Reykjavík Eye Study, 231 from the Vitamin E, Cataract, and Age-Related Maculopathy (VECAT) study in Melbourne, and 92 from the Singapore-Japan Cooperative Cataract Study, all showing early-stage cataract in pupils dilated to 7 mm or more. Scheimpflug and retroilluminated photographs were used to locate opacities. Localization of cortical cataract was determined by dividing the retroillumination image into seven concentric circles with diameters of 1 through 7 mm, and eight sections of 45 degrees radial octants. The positive rate of opacification was then calculated for each quadrant. The highest positive rate of opacification was observed in the lower nasal quadrant in all groups. The relative risk of the prevalence of cortical opacity in the lower nasal oblique hemisphere to the upper temporal oblique hemisphere was the highest in the Singaporean subjects followed by those of Melbourne and then of Reykjavík. The prevalence of cortical cataract was higher in the lower nasal quadrant than in the other quadrants for all subjects of diverse race in three climatically different locations. This higher prevalence was most pronounced in subjects living at low latitude. These results support the view that solar UV exposure is a possible risk factor for development of human cortical cataract.

The impact of rubella immunization on the serological status of women of childbearing age: a retrospective longitudinal study in Melbourne, Australia.

This study assessed the impact of rubella immunization, which commenced in Australia in 1971, on the serological status of women of childbearing age over a 25-year time period and identified the risk factors for ongoing rubella susceptibility.

Patterns and demographic predictors of 5-year weight change in a multi-ethnic cohort of men and women in Australia.

This study investigated 5-year trends in body weight, overweight and obesity and their association with sociodemographic variables in a large, multi-ethnic community sample of Australian adults. This prospective population study used baseline and 5-year follow-up data from participants in the Melbourne Collaborative Cohort Study (MCCS). Population study in Melbourne, Australia. In total, 12 125 men and 17 674 women aged 35-69 years at baseline. Mean 5-year weight change in this sample was +1.58 (standard deviation (SD) 4.82) kg for men and +2.42 (SD 5.17) kg for women. Younger (35-44 years) men and, in particular, women gained more weight than older adults and were at highest risk of major weight gain (> or =5 kg) and becoming overweight. Risk of major weight gain and associations between demographic variables and weight change did not vary greatly by ethnicity. Education level showed complex associations with weight outcomes that differed by sex and ethnicity. Multivariate analyses showed that, among men, higher initial body weight was associated with decreased likelihood of major weight gain, whereas among women, those initially overweight or obese were about 20% more likely to experience major weight gain than underweight or healthy weight women. Findings of widespread weight gain across this entire population sample, and particularly among younger women and women who were already overweight, are a cause for alarm. The prevention of weight gain and obesity across the entire population should be an urgent public health priority. Young-to-mid adulthood appears to be a critical time to intervene to prevent future weight gain.

Community Valuations of Historic Pocket Parks: a Melbourne Study

The internal reserve – an historic form of planned open space creating semi-private parks at the rear of residential allotments and without street frontages S can be found in Australian suburban areas of diverse socio-economic status. Internal reserves commonly express the idealism of the early town planning movement, which envisaged the internal reserve as an embedded community-building mechanism with multiple potential uses. En vogue from 1910–1930, the internal reserve concept proved problematical from the outset. Even today, while many residents agree that their reserves are responsible for the special nature of their domestic environment, others are apprehensive about safety, maintenance and custodianship. Two surveys of residents living around internal reserves in four Melbourne suburbs, conducted in 1979 and 2002, reveal a variety of opinions on the potential and importance of these spaces. Local communities were found for the most part to have negative and ambiguous perceptions of these reserves. With one exception, residents did not value the parks highly as community spaces and alternative uses may need to be explored. The results suggest that a more innovative set of tools and incentives may be needed to reinvigorate the internal reserve as a significant recreation resource for local communities.

Four Literacy Practices roled into One: Drama and Early Childhood Literacies

(2002). Four Literacy Practices roled into One: Drama and Early Childhood Literacies. Melbourne Studies in Education: Vol. 43, No. 2, pp. 53-63.

Stretching the Envelope for Arts Literacy: Arguing for Multiple Literacies through Drama and the Other Arts

(2002). Stretching the Envelope for Arts Literacy: Arguing for Multiple Literacies through Drama and the Other Arts. Melbourne Studies in Education: Vol. 43, No. 2, pp. 64-76.

Digital Drama: A Snapshot of Evolving Forms

(2002). Digital Drama: A Snapshot of Evolving Forms. Melbourne Studies in Education: Vol. 43, No. 2, pp. 130-141.

Engaging with the Other: Drama, and Intercultural Education

(2002). Engaging with the Other: Drama, and Intercultural Education. Melbourne Studies in Education: Vol. 43, No. 2, pp. 26-38.

Asthma and allergy: a worldwide problem of meanings and management?

Asthma and allergy: a worldwide problem of meanings and management?

Equity in Victorian education and ‘deficit’ thinking

(2002). Equity in Victorian education and ‘deficit’ thinking. Melbourne Studies in Education: Vol. 43, No. 1, pp. 83-105.

The place of Liberal studies in Universities

(2002). The place of Liberal studies in Universities. Melbourne Studies in Education: Vol. 43, No. 1, pp. 1-24.

Friendly enemies: Student Tolerance in a Liberal University

(2002). Friendly enemies: Student Tolerance in a Liberal University. Melbourne Studies in Education: Vol. 43, No. 1, pp. 63-81.

Factors Inhibiting and Driving Innovation in ICT Education1

(2001). Factors Inhibiting and Driving Innovation in ICT Education. Melbourne Studies in Education: Vol. 42, No. 2, pp. 105-129.